Effect Measure is a forum for progressive public health discussion and argument as well as a source of public health information from around the web that interests the Editor(s)

Saturday, September 24, 2005

I hope you don't mind . . .

If I change the subject. I'm afraid I can't give you another flu thread because I just came down from the mountain and I don't have any news, but the previous one seems to be doing just fine, so stay with it if you want. Come to think of it I will have a flu bit at the end, so hang in there.

The people are asking me to "do" the prospects for a new FDA Commissioner now that Lester Crawford has retired. Crawford served with about average distinction by Bush administration standards. I'm sorry for the gross insult, but at least I only used one profanity, specifically the "B" word.

So, possible replacements. Brownie is out of work, and he even has relevant qualifications, having investigated the alleged liposuctioning of a horse's ass.* However, in the present climate, the fraternity president probably can't get away with just pulling another brother away from the washtub full of KoolAid and grain alcohol and giving him a fancy job title. He'll probably have to nominate somebody who looks like he knows what he's doing.

Fortunately for the administration, it would be difficult to find a prominent physician/scientist in the field of drug development who doesn't work for the drug companies, even while being on a university faculty. They can easily come up with a candidate who will please the major corporate campaign contributors and who will also have impressive credentials and sail through confirmation. (David Graham and Marcia Angell are probably not waiting by the phone.)

The problem is not who is sitting in the corner office at the FDA. The problem is the fundamental structure of the pharmaceutical research enterprise. As long as the bulk of the money for developing new drugs comes from profit-making corporations, we're going to keep getting new drugs for common, incurable conditions, drugs that aren't necessarily any better than the old ones but at least have some marginal difference that can be sold as an improvement. Heartburn and GRD, allergy, high LDL cholesterol, high blood pressure, depression, schizophrenia, arthritis, that's where the long green is. These are all real problems, and all about as well treatable by off-patent drugs that we've been using for years and know how to use safely, as they are by more recently developed drugs that are still on patent, that cost 10 times as much, and that are heavily marketed, whose potential dangers we don't fully understand. Sometimes those heavily marketed drugs are actually much worse, and even kill people, and sometimes the drug companies even know it.

Since the medical profession seems unable to resist the siren song of a free post-it pad, a free triangular pen, and a free weekend in Aruba, the only protection we have is from those evil, greedy trial lawyers. Let's hear it for them.

Here's the flu bit. One consequence of this system is that vaccine development and manufacturing is a very low priority. Drug companies want people to get sick and stay sick. There's no incentive to give them a shot or two that will keep them healthy, when you could be selling them a pill every day for the rest of their lives. And of course once a vaccine is available, the political pressure to make it available cheaply to all those non-paying poor people is going to be very hard to resist. It wouldn't be a major technical challenge to develop a production facility for influenza vaccine using genetically engineered bacteria, that could crank out orders of magnitude more doses than our present chicken egg method, and ramp up for new strains more quickly -- at least not compared to sending human to Mars. But Aventis sure as hell isn't gong to do it.